Stop Copay Overpay Act
This bill prohibits the Department of Defense (DOD) from charging a covered individual (i.e., individuals enrolled under the TRICARE program) a co-payment exceeding a certain rate for an outpatient visit for mental health or behavioral health under the TRICARE program, regardless of whether the visit is furnished by a specialty care provider. Specifically, the co-payment amount may not exceed the amount of a co-payment that would be charged under the TRICARE program for an outpatient visit for primary care services.
During the one-year period beginning after this bill is enacted, DOD may not increase the co-payment amount charged to a covered individual above the amount that would have been charged in FY2021 for any service (1) furnished by a specialty care provider under the TRICARE program, and (2) that is not an outpatient visit for mental or behavioral health care.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8633 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 8633
To amend title 10, United States Code, to direct the Secretary of
Defense to limit copayments for outpatient visits for mental health or
behavioral health under the TRICARE program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 5, 2024
Ms. Houlahan (for herself and Mr. Reschenthaler) introduced the
following bill; which was referred to the Committee on Armed Services
_______________________________________________________________________
A BILL
To amend title 10, United States Code, to direct the Secretary of
Defense to limit copayments for outpatient visits for mental health or
behavioral health under the TRICARE program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Stop Copay Overpay Act''.
SEC. 2. LIMITATION ON COPAYMENTS FOR OUTPATIENT VISITS FOR MENTAL OR
BEHAVIORAL HEALTH UNDER TRICARE PROGRAM.
(a) Limitation on Mental or Behavioral Health Copayments.--
(1) Limitation.--Chapter 55 of title 10, United States
Code, is amended by inserting after the item relating to
section 1075a the following new section:
``Sec. 1075b. TRICARE program: limitation on copayments for certain
mental or behavioral health visits
``(a) Limitation on Copayments.--Notwithstanding any other
provision under this chapter, the Secretary of Defense may not charge
to a covered individual a copayment in an amount greater than the
amount described in subsection (b) for an outpatient visit for mental
health or behavioral health under the TRICARE program, regardless of
whether such outpatient visit is furnished by a specialty care
provider.
``(b) Amount Described.--The amount described in this subsection is
the amount of a copayment that would be charged to the covered
individual under the TRICARE Program for an outpatient visit for
primary care services during the year in which the covered individual
is being charged pursuant to subsection (a).
``(c) Covered Individual Defined.--In this section, the term
`covered individual' means any individual enrolled under the TRICARE
program, regardless of the beneficiary category of the individual with
respect to such program or the duty status of the individual.''.
(2) Clerical amendment.--The table of sections for such
chapter is amended by inserting after the item relating to
section 1075a the following new section:
``1075b. TRICARE program: limitation on copayments for certain mental
or behavioral health visits.''.
(3) Applicability.--The amendments made by this subsection
shall apply with respect to outpatient visits for mental or
behavioral health occurring on or after the date of the
enactment of this Act.
(b) Temporary Limitation on Other Specialty Care Copayments.--
(1) Temporary limitation.--During the one-year period
beginning on the date of the enactment of this Act, the
Secretary of Defense may not increase the amount of a copayment
charged to a covered individual for any service described in
paragraph (2) beyond the amount that the Secretary would have
charged to the covered individual for such service during
fiscal year 2021.
(2) Services described.--A service described in this
paragraph is a service--
(A) that is furnished to a covered individual by a
specialty care provider under the TRICARE program; and
(B) that is not covered under section 1075b of
title 10, United States Code, as added by subsection
(a).
(3) Applicability.--The limitation on copayments specified
in paragraph (1) shall apply with respect to specialty care
received on or after the date of the enactment of this Act.
(c) Report on Effects of Limitations.--Not later than one year
after the date of the enactment of this Act, the Secretary shall submit
to the Committees on Armed Services of the House of Representatives and
the Senate a report on how the limitation under section 1075b of title
10, United States Code (as added by subsection (a)) has affected, or
may affect, the health care system of the Department of Defense. Such
report shall include--
(1) any findings by the Secretary as to whether the
limitation under such section 1075b may result in an increase
in copayments charged for services described in subsection
(b)(2) after the period specified in subsection (b)(1)
concludes; and
(2) recommendations by the Secretary on how to avoid such
an increase, as applicable.
(d) Definitions.--In this section:
(1) The term ``covered individual'' has the meaning given
such term in section 1075b of title 10, United States Code, as
added by subsection (a).
(2) The term ``TRICARE program'' has the meaning given such
term in section 1072 of such title.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Armed Services.
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